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20142015 INFLUENZA(FLU)VACCINEDECLINATION PRINTABLE Employee# PRINTDEPARTMENT/UNIT Physician Volunteer Other(i.e.contractor, student, etc.) Checking: Associate CHOCChildrenshasgivenmetheopportunitytoreceivetheInfluenzavaccineatnochargetome
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How to fill out influenzafluvaccinedeclination - choc:

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Influenzafluvaccinedeclination - choc is a form used to decline or refuse to receive the influenza vaccine.
Individuals who choose not to receive the influenza vaccine are required to file influenzafluvaccinedeclination - choc.
To fill out influenzafluvaccinedeclination - choc, individuals must provide their personal information and indicate the reason for declining the influenza vaccine.
The purpose of influenzafluvaccinedeclination - choc is to document and track individuals who choose not to receive the influenza vaccine.
The information reported on influenzafluvaccinedeclination - choc typically includes the individual's name, date of birth, reason for declining the vaccine, and signature.
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